Research Progress and Ethical Issues of Brain Organoids / 中国医学伦理学

Organoids are three-dimensional (3D) biological structures constructed in vitro by stem cells, which partially mimic the function of real organs. Brain organoids are an extremely important branch of organoid research. This technology can differentiate pluripotent stem cells into the required cell types in a 3D culture environment, and self-assemble into structural bodies, but it is currently unable to fully replicate the structural and physiological features of the real human brain. The maturity of brain organoids may form consciousness, which poses ethical issues such as determining moral status and informed consent in brain organoids research. This paper elaborated on the research progress and future development direction of brain organoids, and proposed multidimensional governance strategies for ethical issues faced in brain organoids research from the perspectives of ethical principles, ensuring public informed consent, and legal supervision. By exploring the above issues, reference will be provided for formulating ethical principles to guide the research and application of brain organoids in the future.

Conflitos morais vivenciados por enfermeiras dos serviços de emergência: estudo transversal / Moral conflicts experienced by nurses from emergency services: a cross-sectional study / Conflictos morales experimentados por enfermeras de los servicios de urgencias: un estudio transversal

Objetivo: identificar a ocorrência de conflitos morais e as características das enfermeiras dos serviços de emergência. Método: estudo quantitativo, transversal, aprovado pelo Comitê de Ética em Pesquisa, desenvolvido no formato online, com dados coletados em fevereiro a junho de 2022, ao aplicar o Questionário de Sensibilidade Moral. Participaram 330 enfermeiras dos serviços de emergência brasileira. A análise estatística foi realizada pelos testes Kruskal-Wallis e Mann-Whitney. Resultados: a ocorrência de conflitos morais apresentou diferença significativa entre enfermeiras quanto a faixa etária e anos de experiência na urgência, no entanto, o efeito foi fraco. Não foi identificada distinção no que se refere ao sexo, tipo de serviço, função, carga horária. Conclusão: há ocorrência de conflito moral por enfermeiras, algumas diferenças entre as características das enfermeiras nos serviços de emergência, sinalizando a necessidade de aprofundar o estudo sobre os conflitos em contextos específicos de cuidado e fortalecer estratégias para resolução dos problemas éticos.

Objective: to identify the occurrence of moral conflicts and the characteristics of nurses in emergency services. Method: quantitative, cross-sectional study, approved by the Research Ethics Committee, developed in the online format, with data collected from February to June 2022, when applying the Moral Sensitivity Questionnaire. 330 nurses from Brazilian emergency services participated. Statistical analysis was performed using the Kruskal-Wallis and Mann-Whitney tests. Results: the occurrence of moral conflicts showed a significant difference between nurses in terms of age and years of experience in the emergency room, however, the effect was weak. No distinction was identified with regard to sex, type of service, function, workload. Conclusion: there is occurrence of moral conflict by nurses, some differences between the characteristics of nurses in emergency services, signaling the need to deepen the study on conflicts in specific contexts of care and strengthen strategies for solving ethical problems.

Objetivo: identificar la ocurrencia de conflictos morales y las características de los enfermeros en servicios de urgencias. Método: estudio cuantitativo, transversal, aprobado por el Comité de Ética en Investigación, desarrollado en el formato en línea, con datos recolectados de febrero a junio de 2022, al aplicar el Cuestionario de Sensibilidad Moral. Participaron 330 enfermeros de los servicios de urgencias brasileños. El análisis estadístico se realizó utilizando las pruebas de Kruskal-Wallis y Mann-Whitney. Resultados: la ocurrencia de conflictos morales mostró una diferencia significativa entre los enfermeros en cuanto a la edad y los años de experiencia en las urgencias, sin embargo, el efecto fue débil. No se identificó distinción respecto con género, tipo de servicio, función, carga de trabajo. Conclusión: ocurren conflictos morales por parte de los enfermeros, algunas diferencias entre las características de los enfermeros en los servicios de urgencias, lo que apunta hacia la necesidad de profundizar el estudio sobre los conflictos en contextos específicos de cuidado y fortalecer las estrategias para la solución de problemas éticos.

Justiça, cuidado e reconhecimento: trama moral do vínculo terapêutico / Justice, care and recognition: the moral fabric of therapeutic bonds / Justicia, cuidado y reconocimiento: trama moral del vínculo terapéutico

Resumo O objetivo deste ensaio, dividido em duas partes, é investigar a estrutura geral do vínculo terapêutico. A primeira parte descreve agentes sociais como sujeitos moralmente interpelados pela norma fundamental da justiça ("a cada qual o que lhe é devido"), que na cena particular do cuidado se desdobra em potenciais conflitos intersubjetivos. A segunda representa a relação terapêutica articulada com os "três níveis do juízo médico" apontados por Paul Ricoeur - prudencial, deontológico e reflexivo -, conferindo às prescrições desse âmbito o estatuto de relação francamente moral.

Abstract This article investigates the general structure of the therapeutic bond in two parts: a pragmatic description of social agents as subjects morally challenged by the fundamental norm of justice ("to each one what is due"), which in healthcare may also have potential intersubjective conflicts; and a representation of the therapeutic relationship based on Paul Ricœur's "three levels of medical judgment" (prudential, deontological and reflexive), giving the prescriptions in this scope the status of a moral relationship.

Resumen El objetivo de este ensayo, que se divide en dos partes, es investigar la estructura general del vínculo terapéutico. La primera parte describe a los agentes sociales como sujetos a los que la norma fundamental de la justicia ("a cada uno lo suyo") interpela moralmente, lo que, en la escena particular de la atención médica, se desdobla en posibles conflictos intersubjetivos. La segunda parte muestra la relación terapéutica que se articula mediante lo que el filósofo Paul Ricoeur denomina "los tres niveles de juicio médico" -prudencial, deontológico y reflexivo-, confiriendo a las prescripciones de este ámbito el estatuto de una relación francamente moral.

Influence of Mental Health Nurses' Moral Distress and Job Satisfaction on Turnover Intention / 정신간호학회지

PURPOSE: The purposes of this study were to investigate moral distress, job satisfaction and turnover intention of mental health nurses, and identified influencing factors on mental health nurses' turnover intention. METHODS: A descriptive survey was conducted with 85 mental health nurses working in mental medicine department closed wards of 5 hospitals in Busan Metropolitan City and Gyeongsangnam Province. Data were collected from December 1, 2015 to January 31, 2016 and analyzed using percentage, frequency analysis, average, standard deviation, t-test, ANOVA, Pearson correlation coefficient and multiple linear regression analysis, with SPSS/WIN 18.0. RESULTS: 1) Moral distress had a statistically significant positive relationship with turnover intention (r=.24, p=.023). Job satisfaction had a statistically significant negative relationship with turnover intention (r=−.45, p<.001). 2) Moral distress had a positive effect on turnover intention (β=.23, p=.018), and job satisfaction, a negative effect on turnover invention (β=−.44, p<.001). These variables explained 24.0% of the variance. CONCLUSION: Findings indicate that moral distress and job satisfaction are important variables influencing turnover intention in mental health nurses. Development and provision of intervention programs to reduce moral distress and increase job satisfaction will help to decrease nurses' turnover intention.

The localizing analysis of the moral status of the embryo in secular bioethical view / 中华医学教育探索杂志

The discussion of the moral status of the embryo mainly focuses on the debating of human beings and human persons in western country.From the angle of the localizing view,the embryo is not a real person.The abortion can get defended.Considering the embryo has potential and value relationship,it has the limited moral status.In dealing with the problem,we should not protect the embryos by emphasizing the embryo's moral position,but we should control abortion appropriately by humanitarian perspective to respect the embryo.

Etica de la investigación en modelos animales de enfermedades humanas / Ethics of research with animal models for human diseases / Ética da pesquisa em modelos animais de enfermidades humanas

El presente artículo reflexiona sobre las implicaciones éticas de usar modelos animales para el desarrollo de la medicina en seres humanos. Entre las posturas extremas de condenar toda investigación con animales considerándola irrelevante y la de exagerar y promocionar el importante papel de la investigación con animales como modelo para enfermedades humanas, se adopta la postura intermedia de considerar el uso de animales en investigación como necesario en el estado actual de la ciencia para ajustarse al imperativo moral de curar y prevenir enfermedades humanas, pero buscando formas de reemplazar y reducir el número de animales y de disminuir su sufrimiento.

This paper argues about the ethical implications of using animals as models for human medicine development. considering it irrelevant, and that of exaggerating and promoting research with animals as models for human diseases. imperative of curing and preventing human diseases, but methods for replacing and reducing the number of animals as well as diminishing their suffering must be sought.

em sereres humanos. Entre as posturas extremas, uma é a de condenar todas as pesquisas com animais, considerando-a irrelevante e a outra postura, é a de exagerar e promover o importante papel da pesquisa com animais como modelo para enfermidades humanas. Adota-se uma postura intermediária de considerarar o uso de animais em pesquisa, como necessária para o estado atual da ciência para se ajustarao imperativo moral de curar e prevenir enfermidades humanas, porém buscando formas de substituir e reduzir o número de animais e de diminuir seu sofrimento.

A Chinese Ethical View on the Moral Status of Researched Human Embryo / 中国医学伦理学

In January 2004,the long expected written regulation of 'Guidelines for research on human embryonic stem cells' was jointly released by the Ministry of Science and Technology and the Ministry of Health,Beijing,China.In 'Ethical Guidelines for Research on Human Embryonic Stem Cells',The Article 5 say: The human embryonic stem cell used for research can derived from ① spared gamete or blastula remaining after In Vitro Fertilization(IVF);②fetal cells after natural or voluntarily selective abortion;③blastula or monosexual split blastula by somatic cell nucleus transfer technique;④germ cells voluntarily donated;The Article 6 say: any blastula obtained by IVF,somatic cell nucleus transfer technique,mono-sexual reproduction technique or genetic modification cannot be cultured in ex vivo for longer than 14 days,since fertilization or nucleus transfer.Such supporting to the embryo researched gotten by the somatic cell nucleus transfer technique,and supporting the human embryonic stem cell research under the condition of the embryo researched within 14 days,is meeting the objections from native country and some foreign countries.In my paper,I argued that an embryo within 14 days is not a person,an embryo is only a human biological life,a human embryo has a certain value,it deserves due to respect,but if there are enough reasons,it can be used.Destructive embryo research should only be approved in exceptional circumstances.To the blastulas or mono-sexual split blastulas by somatic cell nucleus transfer technique,this is an Ethical issue of creating embryos for research.The majority of bioethicists said it is wrong to create and destroy a person for research.I argued that the Moral Status of Researched Human Embryo is not a person,so, Kant' theory is no used here.I further claimed that a 14 days old embryo could be used for research.I quoted a major view of the moral status of the embryo/fetus from the medical science.A 14 days old embryo is a cluster of cells without bones,organs of other traits;they have a consciousness around 20 weeks,so a 14 days old embryo cannot be hurt.